Healthcare Provider Details

I. General information

NPI: 1194016725
Provider Name (Legal Business Name): JOSHUA CHRISTOPHER BENTON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2011
Last Update Date: 04/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY SUITE 204
WEIRTON WV
26062-5053
US

IV. Provider business mailing address

4575 STATE ROUTE 151
MINGO JCT OH
43938-7931
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-6331
  • Fax: 304-723-1131
Mailing address:
  • Phone: 304-723-6331
  • Fax: 304-723-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0007156
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: